Abstract
A 65-year-old male was treated for gallbladder cancer in September 2014 by gallbladder bed resection and duct-sparing lymphadenectomy, but was readmitted in December 2015 diagnosed with obstructive jaundice and cholangitis. CT imaging showed stenosis of the common bile duct at the cystic duct junction and intrahepatic biliary dilatation, as well as two enlarged lymph nodes approximately 1cm in diameter near the hepatectomy site. After ENBD placement, bile cytology revealed moderately differentiated adenocarcinoma. For radical resection of the recurrent lesions we scheduled right hepatectomy and extrahepatic bile duct resection. We increased residual liver volume to 49.8% preoperatively by portal vein embolization, and performed right hepatectomy, extrahepatic bile duct resection, and combined portal vein resection. Postoperative clinical histology showed localized cancer recurrence, and we suspected recurrence via the cystic plexus. Adjuvant combination chemotherapy with GS was performed for one year, and the patient has survived recurrence-free for two years since surgery. Although the significance of the resection of the localized lesions remains unclear, we believe that if the kind of radical resection in this case can be performed safely, duct stenosis will also resolve, and this is an effective therapeutic method.
